title: Development and testing of an expectations survey for patients undergoing lumbar spine surgery.
abstract: BACKGROUND
  Patients' expectations of lumbar spine surgery have not been obtained with valid and reliable scales derived from patients' perspectives. The objective of this cross-sectional study was to develop and to test a patient-derived expectations survey.
  
  
  METHODS
  The survey was developed in three phases. Phase 1 involved interviews with patients with open-ended questions about expectations and assembly of a draft survey. Phase 2 involved administering the survey twice to assess test-retest reliability. Phase 3 involved selection of final items based on concordance of responses and clinical relevance, and the development of a scoring rubric.
  
  
  RESULTS
  In Phase 1, 118 preoperative patients with diverse lumbar spine diagnoses volunteered 583 expectations, from which thirty-one discrete categories were discerned and became the items for the draft survey. In Phase 2, another fifty-six preoperative patients completed the draft survey twice, four days apart. In Phase 3, twenty-one items were retained for the final survey addressing symptom relief, return to basic mobility, resumption of activities, and improvement in psychosocial well-being. An overall score was calculated on the basis of the number of expectations and amount of improvement expected and ranged from 0 to 100 points; a higher score indicates more expectations. For patients in Phase 2, the mean scores for both administrations were 66 and 65 points, the Cronbach alpha coefficients for both administrations were 0.90 and 0.92, and the intraclass correlation coefficient between scores was 0.86.
  
  
  CONCLUSIONS
  We developed a patient-derived survey that is valid, reliable, and applicable to diverse diagnoses and includes physical and psychosocial expectations. The survey generates an overall score that is easy to calculate and to interpret, and thus fills a gap in the assessment of lumbar spine surgery by offering a practical and comprehensive way to record patients' expectations.
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for C.A. Mancuso: mancusoc@hss.edu.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Mancuso
authors.forename: Frank P
authors.initials: FP
authors.lastname: Cammisa
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Sama
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Hughes
authors.forename: Hassan M K
authors.initials: HM
authors.lastname: Ghomrawi
authors.forename: Federico P
authors.initials: FP
authors.lastname: Girardi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D015203:Reproducibility of Results; D013122:Spinal Diseases / Q000601:surgery*; D055815:Young Adult